Power Of Attorney Over Protected Person Or Minor Child Template
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1
2Power of Attorney over Protected Person or Minor Child
I swear that the following is true:
(1)
I am the
parent
court-appointed guardian of
_______________________________
, who was born on
(name)
_______________________________
.
(date)
(2)
I appoint the following person as my attorney-in-fact for the person named in
Paragraph (1).
Name
Address
City, State, Zip
Phone
E-mail
(Check (3) OR (4), not both. If you check (4), describe the authority being delegated.)
(3)
I delegate to my attorney-in-fact all power and authority that I have as a
parent or guardian, except the power to consent to marriage or adoption.
(4)
I delegate to my attorney-in-fact only the specific authority to:
(5)
This power of attorney lasts until ____________________________
.
(date)
(This
date must be within the next 6 months.)
(6)
This power of attorney lasts even in the event of my disability.
Power of Attorney over Protected person or
Approved Board of District Court Judges January 16, 2009
Page 1 of 2
Minor Child
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